A comparative study of RapidArc and intensity-modulated radiotherapy plan quality for cervical cancer treatment

Atiq, Atia; Atiq, Maria; Iqbal, Khalid; Sial, Muhammad Safdar; Altaf, Saima; Shamsi, Quratul Ain; Buzdar, Saeed Ahmad

doi:10.4103/ijc.ijc_609_17

Cited by 11 publications

(8 citation statements)

References 40 publications

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“…Radiotherapy has achieved a satisfying result in the treatment of cervical cancer, especially with the advent of novel technologies such as intensity-modulated radiation therapy, four-dimensional CT, and image guided radiation therapy, and many research studies have proved that new radiotherapy techniques improve the target doses while reducing treatment-related toxicity 28–31. However, acute and late radiation-induced proctitis and cystitis are still inevitable due to the anatomical position and physical properties of X-rays 32,33.…”

Section: Discussionmentioning

confidence: 99%

<p>Impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer</p>

Ma¹,

Zhang²,

Jiang³

et al. 2019

CMAR

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Objective This study aimed to investigate the impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer. Materials and methods One hundred and sixty-six patients with locally advanced cervical cancer were selected in this retrospective study. The patients were divided into four groups according to their average bladder volume during radiotherapy (external beam radiation therapy and intracavitary brachytherapy): group A: V<100 mL, group B: 100 mL≤V≤150 mL, group C: 150 mL200 mL. The bladder volume and the cumulative dose to planning target (D90), bladder (D2cc), rectum (D2cc), and sigmoid (D2cc) were calculated using the treatment planning system. Treatment outcomes including late adverse events (the maximum grade of radiation-induced proctitis and cystitis), the objective response rate of tumor and lymph node, overall survival (OS), and progression-free survival (PFS) were collected. Additionally, the correlation between bladder volume and the irradiated dose of organs at risk and treatment outcomes was analyzed. Results The median follow-up time was 28 months. The D90 and D2cc of the rectum in group A were the highest ( P <0.05). The D2cc of the bladder in group D was the highest ( P <0.05). There was no significant difference in the tumor and lymph node regression rate, OS, and PFS among the groups. The difference in the late radiation-induced proctitis and cystitis maximum grade among the four groups was statistically significant ( P <0.001, P =0.022, respectively), with group A the most serious and group B the mildest. Conclusion For patients with cervical cancer, the bladder volume significantly affected the delivered dose to target, rectum, and bladder. When the bladder volume range was 100–150 mL, the rate of late radiation-induced proctitis and cystitis was low and the degree of reaction was mild. This is thought to be the optimum bladder volume for patients with cervical cancer during radiotherapy.

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Section: Discussionmentioning

confidence: 99%

<p>Impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer</p>

Ma¹,

Zhang²,

Jiang³

et al. 2019

CMAR

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“…A major deviation is when <80% of prescribed dose is encompassed by target volume. But, in most clinical scenarios, a ±10% deviation is accepted [11].…”

Section: Gi = Ptvpd/ptvpd50%mentioning

confidence: 99%

“…Therefore, in our study, we calculated Integral dose of the body by creating a structure set "Body-PTV" and assessed the same during plan evaluation. Although no ideal threshold value for ID is recommended, it is necessary to maintain it as low as possible without significantly compromising target coverage [11].…”

Section: Udi = Coverage × CI × Hi × Gimentioning

confidence: 99%

“…Significant difference was found between IMRT and RapidArc in favor of RapidArc (p<0.001). Atiq et al compared RapidArc and IMRT in terms of plan quality of Pelvic RT for cervical cancer and concluded that RapidArc was better in terms of homogeneity, conformity, coverage, high gradient index and better normal tissue sparing with comparable integral dose [11]. Literature for comparison of techniques for extended field RT in cervical cancer are lacking.…”

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confidence: 99%

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A Case Series of Dosimetric Comparison-VMAT (RapidArc), IMRT, 3DCRT for Extended Field Radiotherapy in Cervical Cancer

Marimuthu¹,

Ponniah²,

Ganesan³

et al. 2021

austinjnuclmedradiother

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Purpose: To compare plans of 3DCRT, IMRT and VMAT (RapidArc) and evaluate them in different dosimetric aspects along with dose to organs at risk with each technique to determine the best treatment technique for Extended field RT in cervical cancer patients Material & Methods: We evaluated External Beam radiotherapy plans of 10 patients of FIGO 2018 stage rIIIC2 who received Extended Field Radiotherapy (EFRT) to primary site along with regional nodes-bilateral external, internal iliac lymph nodes, presacral and para-aortic lymph nodes. The dose prescribed for all patients was 50.4Gy/28 fractions at 180cGy/fraction. Few patients had received gross nodal boost following this, but for better comparison only the initial phase of 50.4Gy/28 fractions was considered. All patients were planned with 3DCRT, IMRT and RapidArc. We evaluated and compared these plans dosimetrically in terms of Homogeneity Index, Conformity Index, Target Volume Coverage, Gradient Index, Unified Dosimetry Index, Integral dose, Monitor units and Doses to Organs at risk such as Anorectum, Bladder, Bowel Bag, Bilateral Femoral Heads, Bilateral Kidneys and Bone Marrow. Results: Intensity modulated techniques RapidArc and IMRT significantly spared critical organs compared to 3DCRT. Between RapidArc and IMRT, the critical organ sparing was comparable, but RapidArc had better target coverage, lesser MU and lesser treatment time. All techniques had acceptable HI, CI, GI, UDI and whole body Integral dose. Conclusion: Intensity modulated techniques should be the standard for EFRT in cervical cancer. Both RapidArc and IMRT are acceptable techniques of treatment delivery although the former may be preferred if and when available.

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“…The literature on the dosimetric comparison of AAA and AXB algorithms for carcinoma cervix RT is at a premium. The RapidArc (RA) technique has been reported superior for cervix RT as compared to the intensity modulated radiation therapy (IMRT) technique [10][11][12]. Hence, the present study is aimed to quantify the potential benefits of AXB computations on the cervix RT using RA technique as compared to AAA computations.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric impact of Acuros XB on cervix radiotherapy using RapidArc technique: a dosimetric study

Kumar

Kishore

Bhushan

et al. 2021

Rep Pract Oncol Radiother.

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Background: Acuros XB (AXB) may predict better rectal toxicities and treatment outcomes in cervix carcinoma. The aim of the study was to quantify the potential impact of AXB computations on the cervix radiotherapy using the RapidArc (RA) technique as compared to anisotropic analytical algorithm (AAA) computations. Materials and methods:A cohort of 30 patients previously cared for cervix carcinoma (stages II-IIIB) was selected for the present analysis. The RA plans were computed using AAA and AXB dose computation engines under identical beam setup and MLC pattern.Results: There was no significant (p > 0.05) difference in D95% and D98% to the planning target volume (PTV); moreover, a significant (p < 0.05) rise was noticed for mean dose to the PTV (0.26%), D50% (0.26%), D2% (0.80%) and V110% (44.24%) for AXB computation as compared to AAA computations. Further, AXB estimated a significantly (p < 0.05) lower value for maximum and minimum dose to the PTV. Additionally, there was a significant (p < 0.05) reduction observed in mean dose to organs at risk (OARs) for AXB computation as compared to AAA, though the reduction in mean dose was non-significant (p > 0.05) for the rectum. The maximum difference observed was 4.78% for the rectum V50Gy, 1.72%, 1.15% in mean dose and 2.22%, 1.48% in D2% of the left femur and right femur, respectively, between AAA and AXB dose estimations. Conclusion:For similar target coverage, there were significant differences observed between the AAA and AXB computations. AAA underestimates the V50Gy of the rectum and overestimates the mean dose and D2% for femoral heads as compared to AXB. Therefore, the use of AXB in the case of cervix carcinoma may predict better rectal toxicities and treatment outcomes in cervix carcinoma using the RA technique.

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A comparative study of RapidArc and intensity-modulated radiotherapy plan quality for cervical cancer treatment

Cited by 11 publications

References 40 publications

<p>Impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer</p>

<p>Impact of bladder volume on treatment planning and clinical outcomes of radiotherapy for patients with cervical cancer</p>

A Case Series of Dosimetric Comparison-VMAT (RapidArc), IMRT, 3DCRT for Extended Field Radiotherapy in Cervical Cancer

Dosimetric impact of Acuros XB on cervix radiotherapy using RapidArc technique: a dosimetric study

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